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Is Steriodal Injections Necessary For Normal Wrist Sprain?
Question: Case Review:
You are presented with a 56-year-old male, who injured his hand specifically his right wrist playing golf approximately 2 weeks earlier. For this instance imagine you are an orthopedic surgeon specializing in hands. Patient was first seen in ED, X-Ray was negative and prescribed Percocet for pain and sent home for self-care diagnosed with wrist sprain. Additionally he was given a referral to a wrist specialist.
Patient was seen by orthopedic specialist, and the records read "there're no signs of infection, there's no reason to suspect a spontaneous joint infection." Moreover, the physician under sterile conditions the right radiocarpal joint was injected with 1 cc of Kenalog and 2 cc of 0.25% of plain Marcaine. And the patient was placed on a prednisone burst and taper.
This did not work so the hand specialist decided the patient had carpal tunnel syndrome and subsequently gave him carpal tunnel injections. This consisted of 1 cc Kenalog and 1 cc of 0.25% plain Marcaine. No aspiration was completed in either of the injections, even now the hand was swollen, displaying signs of effusions.
Long story short turns out that this gentleman had a septic right wrist. Is now paralyzed, and he was in fact a dentist prior to these injections. So it's quite an interesting matter. I need to find some related material that would support joint aspiration prior to injection of steroids. I also would like your take on this, Given the limited facts that you have been given. Would you have aspirated the joint? Would you have aspirated the joint both times? Would you have sent the fluid from aspiration to the lab? Do you find it odd that this doctor documents the fact that it could be an infection over and over again yet he fails to aspirate the joint and send it to the lab? Would you be willing to help me in finding some materials that would support my position? I of course would be willing to pay extra for this.
You are presented with a 56-year-old male, who injured his hand specifically his right wrist playing golf approximately 2 weeks earlier. For this instance imagine you are an orthopedic surgeon specializing in hands. Patient was first seen in ED, X-Ray was negative and prescribed Percocet for pain and sent home for self-care diagnosed with wrist sprain. Additionally he was given a referral to a wrist specialist.
Patient was seen by orthopedic specialist, and the records read "there're no signs of infection, there's no reason to suspect a spontaneous joint infection." Moreover, the physician under sterile conditions the right radiocarpal joint was injected with 1 cc of Kenalog and 2 cc of 0.25% of plain Marcaine. And the patient was placed on a prednisone burst and taper.
This did not work so the hand specialist decided the patient had carpal tunnel syndrome and subsequently gave him carpal tunnel injections. This consisted of 1 cc Kenalog and 1 cc of 0.25% plain Marcaine. No aspiration was completed in either of the injections, even now the hand was swollen, displaying signs of effusions.
Long story short turns out that this gentleman had a septic right wrist. Is now paralyzed, and he was in fact a dentist prior to these injections. So it's quite an interesting matter. I need to find some related material that would support joint aspiration prior to injection of steroids. I also would like your take on this, Given the limited facts that you have been given. Would you have aspirated the joint? Would you have aspirated the joint both times? Would you have sent the fluid from aspiration to the lab? Do you find it odd that this doctor documents the fact that it could be an infection over and over again yet he fails to aspirate the joint and send it to the lab? Would you be willing to help me in finding some materials that would support my position? I of course would be willing to pay extra for this.
Brief Answer:
Injection was not needed.
Detailed Answer:
Hello,
Thanks for posting your query.
I have read the history in detail. On initial examination there were no signs of infection or inflammation and with a history of injury a sprain was diagnosed.
For the treatment of a wrist sprain only rest and pain killers are needed. There was no need or indication to inject a local steroid in wrist sprain. The first injection itself might have introduced the infection in the joint.
Secondly when the second steroid injection was given there was a considerable swelling. All the signs of infection were present. A joint aspiration and fluid examination was necessary at that time. No MRI scan was ordered to confirm the diagnosis of carpal tunnel.
From the history provided it seems that there was a fault on the part of treating doctor. You can use this transcript as a second opinion to support your case.
Fro the history provided
I hope this answers your query.
In case you have additional questions or doubts, you can forward them to me, and I shall be glad to help you out.
Wishing you good health.
Regards.
Dr. Praveen Tayal.
For future query, you can directly approach me through my profile URL http://bit.ly/Dr-Praveen-Tayal
Injection was not needed.
Detailed Answer:
Hello,
Thanks for posting your query.
I have read the history in detail. On initial examination there were no signs of infection or inflammation and with a history of injury a sprain was diagnosed.
For the treatment of a wrist sprain only rest and pain killers are needed. There was no need or indication to inject a local steroid in wrist sprain. The first injection itself might have introduced the infection in the joint.
Secondly when the second steroid injection was given there was a considerable swelling. All the signs of infection were present. A joint aspiration and fluid examination was necessary at that time. No MRI scan was ordered to confirm the diagnosis of carpal tunnel.
From the history provided it seems that there was a fault on the part of treating doctor. You can use this transcript as a second opinion to support your case.
Fro the history provided
I hope this answers your query.
In case you have additional questions or doubts, you can forward them to me, and I shall be glad to help you out.
Wishing you good health.
Regards.
Dr. Praveen Tayal.
For future query, you can directly approach me through my profile URL http://bit.ly/Dr-Praveen-Tayal
Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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